Afraid in the hospital: Parental concern for errors during a child's hospitalization

OBJECTIVE: (1) To determine the proportion of parents concerned about medical errors during a child's hospitalization; and (2) the association between this concern and parental self-efficacy with physician interactions. STUDY DESIGN: Cross-sectional survey. SETTING: Tertiary care children's hospital. PARTICIPANTS: Parents of children admitted to the general medical service. OUTCOME MEASURE: Parental concern about medical errors. METHODS: Parents were asked their agreement with the statement “When my child is in the hospital I feel that I have to watch over the care that he/she is receiving to make sure that mistakes aren't made.” We used multivariate logistic regression to examine the association between parents' self-efficacy with physician interactions and the need “to watch over a child's care,” adjusting for parent and child demographics, English proficiency, past hospitalization, and social desirability bias. RESULTS: Of 278 eligible parents, 130 completed surveys and 63% reported the need to watch over their child's care to ensure that mistakes were not made. Parents with greater self-efficacy with physician interactions were less likely to report this need (odds ratio [OR], 0.83; 95% confidence interval [CI], 0.72-0.92). All parents who were “very uncomfortable” communicating with doctors in English reported the need to watch over their child's care to prevent mistakes. CONCLUSIONS: Nearly two-thirds of surveyed parents felt the need to watch over their child's hospital care to prevent mistakes. Parents with greater self-efficacy with physician interactions were less likely to report the need to watch over their child's care while parents with lower English proficiency were more likely to report this need. Journal of Hospital Medicine 2009;4:521–527. © 2009 Society of Hospital Medicine.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/64556/1/508_ftp.pd

A Policy Impact Analysis of the Mandatory NCAA Sickle Cell Trait Screening Program

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90062/1/hesr1357.pd

Half a Century of Wilson & Jungner: Reflections on the Governance of Population Screening.

Background: In their landmark report on the "Principles and Practice of Screening for Disease" (1968), Wilson and Jungner noted that the practice of screening is just as important for securing beneficial outcomes and avoiding harms as the formulation of principles. Many jurisdictions have since established various kinds of "screening governance organizations" to provide oversight of screening practice. Yet to date there has been relatively little reflection on the nature and organization of screening governance itself, or on how different governance arrangements affect the way screening is implemented and perceived and the balance of benefits and harms it delivers. Methods: An international expert policy workshop convened by Sturdy, Miller and Hogarth. Results: While effective governance is essential to promote beneficial screening practices and avoid attendant harms, screening governance organizations face enduring challenges. These challenges are social and ethical as much as technical. Evidence-based adjudication of the benefits and harms of population screening must take account of factors that inform the production and interpretation of evidence, including the divergent professional, financial and personal commitments of stakeholders. Similarly, when planning and overseeing organized screening programs, screening governance organizations must persuade or compel multiple stakeholders to work together to a common end. Screening governance organizations in different jurisdictions vary widely in how they are constituted, how they relate to other interested organizations and actors, and what powers and authority they wield. Yet we know little about how these differences affect the way screening is implemented, and with what consequences. Conclusions: Systematic research into how screening governance is organized in different jurisdictions would facilitate policy learning to address enduring challenges. Even without such research, informal exchange and sharing of experiences between screening governance organizations can deliver invaluable insights into the social as well as the technical aspects of governance

Clusters of adverse childhood experiences and unmet need for care coordination.

BACKGROUND: The lack of consensus on how to measure ACEs limits our estimation of their impact on health outcomes and understanding of which ACE clusters drive unmet care coordination (CC) needs. OBJECTIVES: 1) Identify latent classes of ACEs among a representative group of U.S. children; 2) Examine the association between these classes and unmet needs for CC. PARTICIPANT AND SETTING: Using the 2016-2017 National Survey of Children’s Health, we sampled children ages 0-17 the who had seen >1 healthcare provider within 12 months (n=38,758). METHODS: We conducted latent class analyses and weighted logistic regression analyses to examine associations between latent classes and unmet need for CC. RESULTS: We identified seven distinct classes: household poverty and parental divorce, household poverty and parental death, household poverty only, household substance abuse and witnessing violence, multiple ACEs, household poverty and child discrimination, and household poverty and household mental illness. Children in the following classes had the greatest odds of unmet need for CC: household poverty only (AOR 2.0; 95% CI, 1.42- 2.84), household poverty and household mental illness (AOR 1.67; 95% CI, 1.15- 2.44), multiple ACEs (AOR 2.31; 95% CI, 1.53- 3.50), and household poverty and child discrimination (AOR 3.55; 95% CI, 1.71-7.37) . CONCLUSIONS: Children who experienced specific combinations of ACEs, have an increased risk of unmet need for CC, with those experiencing both poverty and discrimination having the highest odds of unmet need for CC. Discrimination widens the gap of unmet CC need for poor children